Ozempic®

Ozempic is a prescription-only medication from Novo Nordisk containing the active ingredient semaglutide. It was originally developed and approved for the treatment of type 2 diabetes. In recent years, Ozempic has also attracted a great deal of attention as a weight-loss medication.

Important to understand: Ozempic is primarily a diabetes medication. For the treatment of overweight without diabetes, the same active ingredient is approved at a higher dose under the name Wegovy. Nevertheless, Ozempic is frequently prescribed "off-label" for weight loss.

The active ingredient semaglutide belongs to the class of GLP-1 receptor agonists. It mimics a natural gut hormone that regulates blood sugar and influences the feeling of fullness. The medication is injected under the skin once a week.

In studies in adults with type 2 diabetes, body weight decreased with Ozempic. After one year, 13% (0.5 mg) and 21 to 24% (1 mg) of those treated had lost at least 10% of their body weight.

Semaglutide mimics the body's own hormone GLP-1 (glucagon-like peptide-1), which has several functions:

1. Appetite regulation in the brain: GLP-1 receptors in the brain influence the satiety center. Semaglutide activates these receptors and leads to a stronger and longer-lasting feeling of fullness. Many users report that they are less hungry and feel full sooner.

2. Slowed gastric emptying: The stomach contents are passed on to the intestine more slowly. As a result, you feel full longer and automatically eat less.

3. Blood sugar regulation (in people with diabetes): Semaglutide promotes insulin release and inhibits glucagon – but only when blood sugar is elevated. This lowers the risk of hypoglycemia.

The result: Most people eat less without constantly feeling hungry. Weight loss occurs primarily through reduced calorie intake, not through increased calorie expenditure.

Study results: In a 2-year study in adults with type 2 diabetes, body weight decreased on average by 3.6 kg and 4.9 kg with 0.5 mg and 1 mg semaglutide respectively, and by 0.7 kg and 0.5 kg with placebo.

Approved indication (Ozempic):

• Adults with type 2 diabetes mellitus to improve blood sugar control
• In combination with diet and exercise
• As monotherapy or in combination with other diabetes medications

Off-label use for overweight: Ozempic is frequently used outside its approved indication in people with overweight who do not have diabetes. For this indication, it is actually Wegovy (higher-dose semaglutide) that is approved.

Typical candidates for treatment:

• BMI ≥ 30 (obesity)
• BMI ≥ 27 with weight-related comorbidities
• Unsuccessful attempts with dietary changes and exercise
• Motivation for long-term lifestyle changes

Less suitable in cases of:

• Type 1 diabetes (not approved)
• History of pancreatitis
• End-stage renal disease (limited experience)
• Pregnancy or breastfeeding
• History of eating disorders

Important: Ozempic is not a lifestyle medication for mild overweight. It is intended for people whose weight endangers their health.

Ozempic dosages (approved for diabetes):

• 0.25 mg weekly – starting dose for 4 weeks
• 0.5 mg weekly – maintenance dose after dose escalation
• 1 mg weekly – further dose increase if needed
• 2 mg weekly – highest available dose

Typical dose escalation schedule:

• Weeks 1-4: 0.25 mg
• From week 5: 0.5 mg
• If needed, from week 9: 1 mg
• If needed, from week 13: 2 mg

For weight loss: Weight reduction is dose-dependent. Higher doses lead to more weight loss, but also to more side effects.

Available pens:

• FlexTouch pen with 0.25 mg
• FlexTouch pen with 0.5 mg
• FlexTouch pen with 1 mg
• FlexTouch pen with 2 mg

The pens contain 4 doses for 4 weeks. For 0.5 mg and 1 mg, pens with 8 doses for 8 weeks are also approved.

Administration:

• Once weekly, on the same day of the week
• Subcutaneous injection (under the skin)
• Possible injection sites: abdomen, thigh, upper arm
• Independent of meals

Injection technique: 1. Take the pen out of the refrigerator (it can be left to reach room temperature for 30 min.) 2. Attach a new needle 3. Set the dose 4. Pinch a fold of skin and insert the needle 5. Press the injection button and hold it for 6 seconds 6. Remove the needle and dispose of it safely

Changing the day of the week: If necessary, the injection day can be changed as long as there are at least 3 days (more than 72 hours) between injections.

Missed dose:

• Within 5 days: Take it as soon as possible
• After 5 days: Skip the dose and continue with the next regularly scheduled injection

Storage:

• Before first use: In the refrigerator (2-8°C)
• After first use: At room temperature (up to 30°C) or in the refrigerator for max. 6 weeks

Contraindication:

• Hypersensitivity: To semaglutide or any of the other ingredients

Outside the approved indication:

• Type 1 diabetes: Ozempic is only approved for type 2 diabetes
• Diabetic ketoacidosis: Not suitable for its treatment

Relative contraindications – special caution:

• History of pancreatitis: Increased risk of recurrent inflammation of the pancreas
• Renal impairment: No dose adjustment needed for mild to severe renal impairment, only limited experience in end-stage renal disease
• Severe gastrointestinal diseases: Gastroparesis, inflammatory bowel diseases
• Diabetic retinopathy: Close monitoring required
• Pregnancy and breastfeeding: Not recommended; discontinue 2 months before a planned pregnancy

Warnings:

• Risk of hypoglycemia: Increased when combined with insulin or sulfonylureas
• Thyroid: Have thyroid nodules or thyroid enlargement evaluated by a doctor
• Dehydration: In case of severe vomiting or diarrhea, make sure to drink enough fluids

Very common (more than 10%):

• Nausea (especially at the beginning)
• Diarrhea

These gastrointestinal complaints are typical of GLP-1 agonists and usually improve after a few weeks.

Common (1-10%):

• Vomiting
• Abdominal pain
• Constipation
• Headache
• Dizziness
• Fatigue
• Flatulence
• Heartburn
• Loss of appetite
• Gallstones (with rapid weight loss)

Uncommon (0.1-1%):

• Changes in taste
• Increased heart rate
• Injection site reactions

Rare but serious:

• Pancreatitis: Severe, persistent abdominal pain – see a doctor immediately
• Severe allergic reactions
• Acute renal insufficiency (with severe dehydration)
• Worsening of diabetic retinopathy

Tips for nausea:

• Increase the dose slowly
• Smaller meals
• Avoid fatty foods
• Drink enough fluids

Important interactions:

Insulin and sulfonylureas:

• Increased risk of hypoglycemia
• Dose reduction of these medications often necessary
• Close blood sugar monitoring

Oral medications:

• Ozempic slows gastric emptying
• The absorption of other medications may be altered
• Particularly relevant for time-critical medications (e.g. antibiotics)

Oral contraceptives:

• A reduced effect of oral contraceptives due to semaglutide is not expected
• In case of gastrointestinal complaints, consider additional contraception

Warfarin and other anticoagulants:

• INR checks recommended at the start and when the dose is changed

Alcohol:

• May increase the risk of hypoglycemia (in people with diabetes)
• May intensify gastrointestinal side effects

General note: Tell your doctor about all medications you are taking. For some active ingredients, adjusting the time of intake may be advisable.